Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE The quality rating for this care home is:
zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marian Whittam
Date: 2 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home
Name of care home: Address: Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE 01539738800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): peterw@abbeyhealthcare.org.uk Abbey Healthcare (Huntingdon) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 86 Number of places (if applicable): Under 65 Over 65 50 28 0 dementia old age, not falling within any other category physical disability Additional conditions: 4 0 4 The home is registered for a maximum of 86 service users to include: up to 28 service users in the category of OP (old age not falling within any other category) up to 50 service users in the category of DE(E) (Dementia over 65 years of age) up to 4 service users in the category of DE (Dementia under 65 years of age) up to 4 service users in the category of PD (Adults with physical disabilities) Date of last inspection Brief description of the care home Heron Hill is a new purpose built home caring for up to 86 people with nursing needs and it opened to residents in October 2004. It is in a quiet residential area with access to the bus routes and the train station. The town centre of Kendal is about 2 miles away. There is a car park at the front of the home. Care Homes for Older People
Page 4 of 34 Brief description of the care home The home is on three floors and there is a passenger lift to all floors. All the bedrooms are single and have en suite bathrooms with showers. There are 2 communal bathrooms and toilets on each floor and separate communal lounges and dining rooms on each floor and an activities room on the first floor. The home has a statement of purpose and service user guide for prospective residents available on admission. A copy of the most recent inspection report is displayed on the notice board in the foyer of the home along with the results of the home?s own satisfaction surveys and the complaints procedure. The scale of fees charged ranges from 633.31 pounds, plus nursing contribution (social services fees) to 831.30 pounds plus nursing contribution (private funded) as at the date of this inspection. There are additional charges to residents for hairdressing, private chiropody, papers and magazines and any personal toiletries. Additional charges for people living there who fund their own fees privately do not apply. Care Homes for Older People Page 5 of 34 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 0 stars. This means that the people who use this service experience poor quality outcomes. This site visit to Heron Hill Care Home forms part of a key inspection. It took place on 26.05.09 and we (CQC, The Care quality commission) were in the home for six and a half hours. We gathered information about the service in different ways: 1. We sent an Annual Quality Assurance Assessment (AQAA) form to the home and this was completed by the registered manager Mrs Janet Barton and returned by the date requested. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from Care Homes for Older People
Page 6 of 34 the providers of services and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. 2.We sent out surveys to people living at Heron Hill and to the staff who work there. We also sent out surveys to health and social care professionals who come into contact with the people living and working there. 3. We looked at all the information we have about the service, any changes they have made and how the manager has dealt with any complaints or safeguarding vulnerable adults. We looked at what the manager has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 4. We spent time talking to people who live there, and spent time with them at mealtimes to see what happens during their day and see what they think about the way the home is run for them. We also spent time talking with domestic, laundry, catering and care staff who work there to get their views and experiences of working there. 5. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. During the day we spent time talking with people living at Heron Hill, in the lounges and also in private. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. The Pharmacist inspector also visited the service as part of this key inspection and assessed the handling of medicines through the inspection of relevant documents, storage, and meeting with the acting manager and staff. What the care home does well: What has improved since the last inspection? Since the last inspection improvements have been made to the way meal times are organised to improve the mealtime experience for people living there. Lunch is now in 2 sittings so staff are available to give prompt and individual support to people to help them eat and enjoy their meals when they are hot and maintain their independence as much as they can. We joined people for lunch and found it to be a calm and sociable occasion. People were being provided with appropriate aids to help them eat and enjoy their food. The activities and recreational provision has been increased with another coordinator to offer more variety. The Provider has reviewed the systems and support available to staff so they can feel secure in reporting concerns about poor practice by colleagues and management. Staff we spoke to felt more relaxed in raising concerns than at the last visit. Morale seemed Care Homes for Older People Page 8 of 34 to have improved and the staff felt the acting manager was approachable and supportive. Overall staffing issues have been addressed with additional staff recruited and stricter monitoring on working long hours and appropriate breaks between shifts to make sure staff can work safely. The number of staff with NVQ level 2 and 3 qualifications in social care has continued to increase so staff can gain the skills and knowledge to support and care for the people living there. The home has also attained ISO 9001 certification which is a quality management system to help them monitor performance. We found that medication was no longer prepared in advance and staff adopted appropriate hygiene measures when giving out medicines so reducing the risk of tablets getting mixed up and cross infection. Changes have been made to the handling of peoples money to safeguard their interests with 2 people checking out any monies and a regular audit by the operations manager. What they could do better: The service is without a registered manager at present as the manager has recently resigned. As a short term interim measure the deputy manager has been acting as manager for the home. The Provider is starting to recruit for a suitably experienced and qualified manager to take up the post and begin the registration process with CQC. We recommend that the registered provider should make sure they have a plan in place to support and guide the acting manager to maintain the day to day running of the home whilst the registered managers post is vacant. This will support the deputy in developing their skills as part of their development and most importantly make sure the acting manager has the resources and help needed to maintain the effective running of the service for the people who live there. We found significant areas of concern and a need to improve in regard to medication. Records for receipt, administration and disposal of medication were poor and in some cases we could not tell if medicines had been administered as prescribed by the doctor. Also some medication was missing and could not be accounted for. We saw medication that was not consistently recorded for disposal and some was disposed of inappropriately. Changes to medication were not always transferred accurately from one administration record to the next at the start of the next four week cycle so that residents received the wrong treatment. This must be improved to to prevent errors that could cause harm to people. Medication was not always given at the correct time in relation to food so that it may not be safe or effective. Medication must always be given at the right time in relation to food so that it is safe and effective. We strongly recommended that audits of medication are more thorough so that problems can be identified and managed promptly. We discussed with staff the special handling precautions relating to a medication. They were unaware of this. The home should have procedures for safe handling of hazardous medicines to protect the staff who handle them. We strongly recommended that procedures are in place for medication with special handling requirements to protect staff. There was a requirement from the last inspection which was not being met. This was Care Homes for Older People Page 9 of 34 that there must be a system for checking unexpected changes in medication to prevent errors being made and people getting the wrong treatment. This must be addressed as a matter of importance and urgency. We found that concerns about the loss of property on one occassion had not been fully followed up to protect people. The registered persons must make sure that all complaints and allegations affecting the welfare and rights of people living in the home are followed up promptly and the appropriate actions taken, in line with current safeguarding vulnerable adults procedures. This is because peoples safety and rights may be affected if incidents and allegations are not promptly addressed and fully recorded. Staff also need to be made aware that decisions regarding whether or not to report concerns about abuse and possible theft are not a matter of individual conscience but should be considered a professional duty. Overall the environment of the home is accessible and comfortable but we found that there is no secure outdoor space for people with dementia to easily and freely access. We recommend that the manager looks at ways to make sure people with cognitive impairments on the EMI suites are able to easily use the outside space to sit out and enjoy the sunshine in safety as they wish. Overall the home has are robust recruitment procedure but we strongly recommend that the manager does checks to make sure that all staff have had all safety checks done before they start work so no one slips through by accident. This good practice would help to make sure the staff working in the home are suitable to work with vulnerable adults. Checking the homes records we found that not all incidents and events that should have been notified to CQC had been. The registered person must inform CQC without delay of any occurrence of injury, any theft and any event in the home which adversely affects the well being or safety of anyone living in the home. This will ensure that CQC is aware of any accidents or incidents in the home that might affect the safety or care of people living there. Overall the pre admission assessments we saw were of a good standard but we recommended that registered manager or person doing the a pre admission assessments for people should take care and check all details on the initial assessment are correct. This way the person can be assured their needs will be understood and met on admission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 Details of our findings
Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 34 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of coming to live at Heron Hill are provided with information about the home to help them in their decision and have their needs assessed before they come to live there so they can have their needs identified Evidence: The home has a statement of purpose and service user guide that is subject to review, to keep the information up to date as changes occur. The service also has a colour brochure with photographs of the inside and exterior of the home to give people an idea of the facilities and location. The information in the statement of Purpose and the service guide can also be made available, if requested in other formats to suit individual needs. The information and leaflets on the notice board and in the main hall also give information about what is going on in the home, including the activities programme
Care Homes for Older People Page 12 of 34 Evidence: and menus. There are information leaflets for useful organisations and satisfaction surveys are available for use by anyone coming into the home to complete for feedback. The manager, or currently the acting manager and senior staff, do the pre admission assessments with people before they come into the home. This is to help make sure that the service will be able to meet peoples individual needs and expectations when they move in. People thinking of coming to live in the home, and their families, are welcome to visit the home beforehand and look around and speak with staff and other people living there. Survey responses from people living there indicate that they felt they had enough information to help them decide if the home would suit them. There is a trial period for people following admission that is completed by a review of care with the person to make sure the home is meeting their needs and expectations. We looked at the pre admission assessments that had been done for people living in the home now and six peoples in detail. Overall the pre admission assessments we looked at contained the relevant information about peoples needs and preferences from which staff could begin to develop care plans with people. We did, however, note that an initial pre assessment for one person showed they required a normal diet when they had diabetes and needed a sugar free diet. The registered manager or person doing the a pre admission assessment should take care and check all details on the initial assessment are correct so the person coming in can be assured their needs will be understood and met on admission. Following admission this error was noted by staff on the unit and so rectified. Where a care management plan or nursing assessment had been done by social services or healthcare agencies a copy was kept and information included in the assessment information. Care Homes for Older People Page 13 of 34 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Heron Hill have their health, personal and social care needs assessed and an individual plan of care prepared with them but the management of the medicines and recording was poor and this places peoples health and well-being at risk. Evidence: All people living at Heron Hill have an individual plan of their care that is easy to follow and generally well set out. We looked at care plans on all three units in the home and at six peoples in detail. The information in the care plans we looked at had been based on initial assessments and sets out a persons health, nursing and personal care needs and relevant clinical risk assessments, including nutritional, falls, moving and handling and skin care. Individual plans for the assessed areas and the nursing and care staff actions needed to meet them are generally in place. These had been reviewed monthly and were generally up to date and gave a reflection of current needs and preferences. A social history and social assessment had been done with people, providing a picture
Care Homes for Older People Page 14 of 34 Evidence: of what was important to people in their life, now and previously. This is important and useful information about a persons interests especially for those people who have difficulty communicating. Peoples communication needs are being assessed so staff should know the best approaches for different people. We spoke to one visitor who came to see their relative 2-3 times each week. Their comments about the staff and the care and support given to their relative were positive. They remarked how kind and patient the staff were with their relative who they said has no communication at all but the staff seem to know exactly what she wants. However we observed on Cavel suite that one staff member was assisting two people to eat their meal at the same time. Using such an approach was not promoting personal or individualised care to either person being helped and did not promote their dignity or independence. Staff should always be aware of the need to respect a persons individuality and dignity at all times and put that into practice during care and support. A full pharmacy inspection was done on Cavel unit only. Overall we found areas where the management of medicines was poor and this places peoples health and well-being at risk. Records for medication were not always accurate increasing the risk of errors. We found records that said that medicines had been given when they had not. Also some medication was missing and could not be accounted for. We saw medication that was not consistently recorded for disposal and some was disposed of inappropriately. Medicines administration records were renewed every four weeks and we checked that information was correctly transferred from one record to the next. We saw the dose of one medication that was halved by the doctor. However, this dosage change was not transferred to the new medication record at the start of the next four-week period. This resulted in the resident receiving double the prescribed dose for the first day until the error was spotted. We saw some medication that must be taken half to one hour before food on an empty stomach that, according to staff, was administered in the dining room at lunch and tea time. Insufficient time would pass between medicines administration and taking food and this would make the medication ineffective. Medicines must be given at the right time in relation to food so that they are safe and effective. We saw a when required medication for diarrhoea that had been given but was not recorded on the administration record. The record, however, recorded the administration of a different when required medication with a similar name that was used for agitation. Although records said that the home had received medication for agitation staff at the home from where the resident had been transferred said they did not supply any so it could not have been received or given. We were told that the staff
Care Homes for Older People Page 15 of 34 Evidence: who gave this had made a medication error. It was not possible to tell if the resident received the correct medication that was appropriate to their needs as records did not say why it was needed. We discussed with staff the special handling precautions relating to a medication. They were unaware of this. The home should have procedures for safe handling of hazardous medicines to protect the staff who handle them. Records for visits by health care professionals and subsequent changes to medication were checked and these were good. We could clearly see when and why changes took place. Care plans for the management of medication were mostly good and informed staff of the proper management of, for example, when required medicines so that residents could receive safe and effective treatment. We checked medicines liable to misuse called controlled drugs on all units. The stock balances were in order and we saw that staff checked stock regularly twice a day. However, some records were incorrect and suggested that these medicines had been administered when they had not. All records for controlled drugs must be kept accurately. Regular checks, or audits, of medication were done but it is recommended that these are more thorough so that problems can be identified and corrected promptly. Care Homes for Older People Page 16 of 34 Daily life and social activities
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Heron Hill have a choice of nutritious meals available to them and the opportunity to take part in organised social activities or follow their own interests if they want and maintain social and family contacts. Evidence: We saw from our observations during the visit, from surveys we got back from people living there and from records and speaking to people living in the home that there are opportunities available to take part in a programme of organised activities and social events. The activities programmes are on display in the foyer and on the different suites and include music and movement sessions, quizzes, 1 to 1 sessions, bingo and sing alongs and music. The programme offers people different activities morning and afternoon. During the visit we saw one of the 3 activities coordinators leading people involved in singing and playing musical instruments on both the EMI suite in the morning and the nursing suite in the afternoon and doing a quiz on Mac Kenzie EMI suite. People were joining in and playing their instruments and engaged with the activities and with other people. There are planned social outings, gardening sessions and art and crafts and manicure and hand massage on a 1 to 1 basis. Some people preferred not to take part in organised sessions and did not have to do so. One person
Care Homes for Older People Page 17 of 34 Evidence: on the nursing unit told us, I prefer to read in my room, the staff will come if I ring. The home provides opportunities for people to take part in religious observance or follow their own faith with access to their own priests or ministers. There is a multi denominational church service and holy communion for those who want it each month. The people we talked with who who were visiting there told us they were made welcome by the staff and it was obvious that the staff knew them well. They felt they could speak to staff and were kept informed about any changes that would affect their relatives or their care. All the care plans we looked at had a personal profile and social assessment and preferences for people. We looked at the care plan for one of the younger people living in the home and spoke with them to see if their social expectations were being met as they wanted. They enjoyed using a computer and had their own in their bedroom along with a printer. They told us that they went out with family and friends frequently and had been out to the pub next door the previous evening for a drink and they were going out again today. They told us they enjoyed music and had a CD player they used in their room and were able to follow their other interests such as photography with their digital camera and keep in touch with their friend and family using their mobile. Their care plan identified these things. The home does also have its own computer for people living there to use with Internet connection. During our visit one of our inspectors sat for over 2 hours in two lounges on Cavell unit to observe the interaction between the staff and residents. The staff on this unit care and support residents who have various forms of dementia and includes some residents have little or no communication skills. We noted that staff interacted very well with all the residents even though many of them were just sitting quietly or sleeping. Staff always spoke to people in a calm and kindly manner. We observed staff assisting the residents to mobilise using various types of hoists. On most occasions staff explained to residents, explaining what was happening and reassuring them. Family members who were visiting said they were treated more like friends and it was obvious that the staff knew them well. One visitor who came into the home several times a week told us Care is outstanding and the food is very good. We visited the kitchen and spoke with the chef and looked at the menus in use. The kitchen was clean, well equipped and had 5 stars from their last environmental health assessment. The menus we saw and the food we saw being served to people at mealtimes was varied and nutritious and from what we could see and people told us was well presented and hot when served. The meals come from the kitchen area and are served by the staff. This was done in an unhurried and calm manner although many of people
Care Homes for Older People Page 18 of 34 Evidence: did need encouragement or assistance with their meals. Care Homes for Older People Page 19 of 34 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are complaints, whistle blowing and adult protection procedures in use in the home but peoples concerns and complaints have not always been appropriately acted upon to make sure that their interests and legal rights are fully protected. Evidence: The service has a complaints procedure, including timescales for action, and this is displayed throughout the home and in the service guide with contact numbers for appropriate agencies for support. Survey responses from people living there and what they and visitors told us during the visit indicated that overall people do know the process for making a complaint. One relative told us I know how to but I have never needed to make a complaint yet . There have been 5 written complaints logged as received in the last year and these were investigated and upheld. There has been one investigation under safeguarding vulnerable adults procedures and where necessary the home manager has made referrals to the Protection of Vulnerable adults register. We spoke with the acting manager about logging concerns or complaints made to staff verbally on the units. We recommended that a record is kept of concerns or complaints raised verbally not just those made in writing. This way matters may be dealt with at an early stage and people will know they are being listened to and action will be taken. Care Homes for Older People Page 20 of 34 Evidence: There are adult protection procedures and guidelines in place to help protect the welfare of people living there and the local multi agency guidance is available for staff to refer to. The procedures are detailed and training records show that staff have been given training on safeguarding vulnerable adults and recognising what abuse may be. This should help staff be aware and act quickly should they suspect abuse. Staff we spoke to and their survey responses indicated that they knew what the procedures were should a situation arise that needed referring to other agencies for someones protection. However, we found that a concern had been raised by a person who had lived at the home and by a family member on their behalf regarding the loss of an item of value to them. We found this this was noted in their care plan daily records and that a search had been made by staff. The incident had not been logged for investigation by the registered manager in the complaints log and no formal investigation is recorded as having been undertaken by the manager or senior staff as a result of the loss of the item of value. Multi agency guidance on safeguarding adults in Cumbria is clear that the manager should undertake initial enquiries and where it is possible that an offence has been committed the police should be notified. Staff need to be aware that concerns about abuse, in this case possible financial, are not a matter of conscience but are a professional duty. People living in the home need to be sure their legal rights will be protected and upheld, just as any other person would expect, through reporting to the appropriate agencies for investigation. We discussed with the acting manager that all concerns raised must take seriously and they should listen carefully to concerns raised by people living there and make sure appropriate records are kept of both the concern and the outcomes and actions taken. Where it is possible that an offence has been committed the police must be notified, Adult Social Care and CQC. It needs to be noted that the registered manager was in post at the time so the responsibility lay with them. The home has whistle blowing procedures in place for staff to report concerns about the practices of colleagues and managers. Staff we asked about this were aware of the procedure and that this had been the subject of a review by the service providers. Staff said that they felt more relaxed in this now and one said We work well now as a team. Care Homes for Older People Page 21 of 34 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Heron Hill provides a comfortable and clean environment that is being maintained and decorated to a good standard. Evidence: We made a tour of the building, including the laundry and kitchen, and the areas used by people living there. We found that the home was being well maintained and we saw the maintenance person attending to day to day maintenance matters during the day. Records are kept of any maintenance work needed and done. There is a programme of testing of lighting, alarms and safety equipment and records are kept. There was a good standard of decoration within the home and it was clean and fresh with no lingering odours evident. The home has domestic staff on each of the 3 suites. We spoke with them as they went about their work and they told us that for larger jobs, such as carpet cleaning, they had 2 domestics working together. The lounge and dining areas were clean and homely with appropriate lighting and seating suited to peoples different needs. There are policies and procedures in place for infection control. There is an infection control audit in place with one person taking responsibility for the training and the audit. This helps to monitor infection control and if staff are following procedures. Training records indicated that staff have been given training on infection control. There are suitable sluice and disinfecting facilities on each
Care Homes for Older People Page 22 of 34 Evidence: of the 3 units to promote good hygiene. There are also alco-gel dispensers on the ground floor and at the entrance for staff and visitors to use to help minimise infection risks generally. The laundry facilities are on the top floor of the home and well away from the areas used by the people living there. We visited the laundry which was clean and well organised with separate clean and dirty laundry areas and hand washing facilities. There are laundry staff to cover a 7 day period, although night staff will make sure any soiled bedding is laundered before they go off duty if needed. We spoke to the two laundry staff on duty and they were clear about how to segregate laundry and the handling of items to reduce the potential spread of infection. There is sufficient comfortable communal rooms in the home for people to relax in or join in social group activities. The communal areas are well lit and warm and there is an area on the ground floor for people to use the homes computer if they want and a smoking room for those who want to smoke. There is also a separate hairdressing salon on the ground floor and we spoke with the hairdresser and people using the salon that morning. The people we talked with liked being able to get their hair done regularly. Outside on the ground floor there are pleasant patios with appropriate seating areas for people to use to sit out in good weather. However we noticed that for the people with dementia care needs on the first and second floors they are no secure garden areas for them to use to sit out with ease and be safe. It was a hot sunny day and we did not see anyone from the dementia care units using the outdoor space or enjoying the sunshine. This could result in people with dementia having less access to to and enjoyment of the grounds than those living on the ground floor. We recommend that the manager looks at ways to make sure people with cognitive impairments are able to use the outside space safely so they can enjoy the warm weather too. All the bedrooms in the home are single and have en suite toilets, wash basins and showers for people. There are also separate toilets, shower rooms and bathrooms with assisted baths on all the suites in addition. The bedrooms we saw were comfortable and well furnished and decorated and all the bedrooms now have nursing beds. There is a range of equipment in the home, bathing aids, nursing beds, and moving and handling equipment to help people with mobility and independence. Many people living there have chosen to make their bedrooms more personal with their own belongings, pictures, ornaments and photographs. People we spoke with liked their bedrooms and many people on the dementia care suites had their own pictures or pictures of things that had meaning for them on their bedroom doors to help them recognise their own rooms and so make them better orientated and independent. People we talked with
Care Homes for Older People Page 23 of 34 Evidence: confirmed that their rooms were cleaned and kept tidy and survey responses also indicated that the home was generally fresh and clean. Care Homes for Older People Page 24 of 34 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty in the home who have received appropriate training to meet the personal and health care needs of the people living there. Evidence: We looked at the staff rotas to assess staffing numbers and skill mix to meet the needs of the people living on all the suites at Heron Hill. The rotas were clear and legible and observation during the visit indicated that there were sufficient staff on duty with a range of skills and experience to provide nursing and personal care for the people living there. We discussed with the acting manager the need to review staffing levels and skill mixes in light of any changes in dependency of the people being cared for. Staffing levels on both Nightingale, the nursing unit and Cavell, the larger dementia care suite, have both been increased over the last year to better meet supervision and peoples personal needs generally and staff are not working long periods of days without a break. On both these units there are 2 registered nurses on duty during the day and one at night and there is a senior carer on each during day shifts. MacKenzie, the smaller dementia care unit also always has a registered nurse on duty day and night. We spoke with several staff working in different areas of the home during the visit. They commented on there being a feeling of teamwork and lately a more relaxed
Care Homes for Older People Page 25 of 34 Evidence: atmosphere. Their survey responses indicated they felt there was good communication and that they gave a good standard of care and did their best to provide good care to people. Staff commented on their training and that there is always training in the home for the staff to improve the standards of care. Staff told us and individual training records showed that they had been given induction training and that this had covered moving and handling, fire training, communication, food hygiene and abuse awareness. One person said We have regular training, we do our NVQ and any other courses that may be significant in our role. Records showed that training was being made available in advanced care planning, dementia care, deprivation of liberty awareness and first aid and resuscitation. Over 50 per cent of staff do have NVQ level 2 in care or above and there is an annual training plan in place. Overseas staff are given additional support with a literacy and numeracy induction as well. We looked a sample of recruitment records and for some new staff. Overall the recruitment procedure was being followed and staff had all necessary security checks done before they started work to help be sure they were suitable to work with vulnerable people. However we found one record that indicated the staff member had started work before the checks had been done. The acting manager could not explain why this was the case. This was the only shortfall we found in the recruitment records and so we recommended that that the manager made sure that all staff had all safety checks done before they started work to make sure the staff were suitable to work with vulnerable adults. If there was an appropriate reason why that did not happen then the reason needs to be must be fully explained on the persons file and what the manager was doing to make sure people living there were not at risk. Care Homes for Older People Page 26 of 34 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have an experienced and qualified registered manager in post at present and whilst there are systems and procedures in place to monitor quality the failure to notify us about all events in the home that might adversely affect people means that their best interests may not always be promoted. Evidence: The home is without a registered manager at present and one of the unit managers, who worked with the former registered manager as a deputy, is now acting manager. The acting manager is a registered nurse but does not hold appropriate management qualifications at present. They are going to do the Level 4 NVQ in management and have some basic management experience but minimal experience of running the entire home. From observation during the inspection the acting manager was being effective in day to day management and maintaining current systems. This can only be a short term measure as the home, which is a large home, now has an inexperienced acting manager and no permanent deputy to help oversee clinical standards. We discussed
Care Homes for Older People Page 27 of 34 Evidence: this with the operations manager who following the managers resignation has begun the recruitment process for a suitably qualified and experienced manager for the post. We recommend that the registered provider should make sure they have a plan in place to support and guide the acting manager to maintain the day to day running of the home whilst the registered managers post is vacant. However staff we spoke to found the acting manager to be approachable and supportive and morale was good amongst the staff we spoke with. Records indicated that staff were being given formal supervision. There are quality monitoring systems in place and the providers require a monthly quality report on any accidents or incidents reported in the home and reported to us (CQC). Policies and procedures are subject to review and the procedure files are available for staff to refer to. Satisfaction surveys are available within the home for people living there to use as well as those for relatives, visitors and visiting professionals so they can give feedback on the service. There are also residents and relatives meetings and records are kept of these and the topics discussed. Records and personal information about people living in the home are being kept securely. We looked at the procedures and records for peoples and spoke with the administrator on the handling of personal finances. Each entry for peoples money is now checked in and out by 2 members of staff. The individual money record sheets are audited every 3 months by the operations manager who does a random check at each of his monthly visits. The service has achieved accreditation with ISO 9000. This is the accepted standard for monitoring an organisations quality monitoring systems and procedures. We found from training records and speaking to staff and from staff surveys that they have received training on safe moving and handling, infection control and fire safety.The fire safety equipment is serviced under annual contracts and records for lift and hoist servicing were up to date. There was a fire risk assessment completed this year and fire alarms and detectors, emergency lights are regularly tested. The nurse call system has been checked regularly as are the water temperatures. We looked at a sample of records of accidents and incidents affecting people living in the home. The manager kept records of accidents and incidents in the home and information on this was passed to the provider for quality monitoring. However we found that notifications of some events that might adversely affect the well being or safety of people living there, including some falls and injuries and the possible theft had not been sent to us, although recorded by the manager. It is a legal requirement and the registered persons must ensure notifications are sent to CQC promptly. Notifications are one important way we (CQC) can see what is happening in the home and what the home is doing to keep people safe and protect their interests.
Care Homes for Older People Page 28 of 34 Evidence: Care Homes for Older People Page 29 of 34 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 9 13 (2) There must be a system for 16/06/2008 checking for unexpected changes in medication to prevent errors being made and people getting the wrong treatment. Care Homes for Older People Page 30 of 34 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be given at the right time in relation to food. This is so that when the medication is given it is safe and effective. 01/07/2009 2 9 13 Records for receipt, administration and disposal of medication must be accurate. This is to prevent errors that could cause harm to people. 01/07/2009 3 9 13 There must be a system for checking for unexpected changes in medication. This was to be met by 16.6.08 This is to prevent errors being made and people getting the wrong treatment. This was to have been met by 16.6.08 01/07/2009 4 18 12 The registered persons must 01/07/2009 make sure that all incidents and allegations affecting the
Page 31 of 34 Care Homes for Older People welfare and rights of people living in the home are followed up promptly and the appropriate actions, in line with current safeguarding vulnerable adults procedures are always followed. This is because peoples safety and rights may be affected if all incidents and allegations are not promptly addressed and fully recorded. 5 38 37 The registered person must 01/07/2009 inform CQC without delay of any occurrence of injury, any theft and any event in the home which adversely affects the well being or safety of anyone living in the home. This will ensure that CQC is aware of any accidents or incidents in the home that might affect the safety or care of people living there Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No. Refer to Standard Good Practice Recommendations 1 3 The registered manager or person doing the a pre admission assessments for people should take care and check all details on the initial assessment are correct so the person can be assured their needs will be understood and met on admission. It is recommended that audits of medication are more thorough so that problems can be identified and managed promptly.
Page 32 of 34 2 9 Care Homes for Older People 3 9 It is strongly recommended that procedures are in place for medication with special handling requirements to protect staff. When assisting people to eat their meals staff should always offer such assistance in a way that shows respect for the individual and promotes their dignity and individuality. We recommend that a record is kept of concerns or complaints raised verbally not just when in writing. This way matters may be dealt with at an early stage and people will know they are being listened to and action will be taken. People living in the home should have their concerns reported to the appropriate agencies to ensure their their legal rights protected and upheld just as any other person would expect. Staff need to be aware that decisions regarding whether or not to report concerns about abuse and possible theft are not a matter of individual conscience but should be considered a professional duty. We recommend that the manager looks at ways to make sure people with cognitive impairments on the EMI suites are able to use the outside space to sit out and enjoy the sunshine in safety. The registered provider should make sure they have a plan in place to support and guide the acting manager to maintain the day to day running of the home whilst the registered managers post is vacant. 4 10 5 16 6 17 7 18 8 20 9 31 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
